WASHINGTON  In an effort to move from "worst to first," the nation's capital opens a new 911 command center next Tuesday in hopes of improving its response to emergencies, attacks and disasters.

The city says the Unified Communication Center, which also answers routine inquiries about everything from garbage pickup to neighborhood complaints, is key to improving emergency response.

In a national catastrophe, the $116 million center will connect local officials with surrounding states and the federal government. But day to day, it will be the place where life-and-death decisions are made when anyone in the city needs help. And that's a large pool: more than 550,000 residents and 2 million commuters and tourists.

City officials have been much maligned for highly publicized cases in which deaths have been blamed on the failure of emergency workers to respond in a timely and competent manner. In fact, Washington's emergency medical service response was found to be among the worst of the nation's 50 largest cities in a USA TODAY investigation in 2003. Mayor Anthony Williams vowed then to improve the city's ability to save lives as part of his "worst to first" effort.

"The Unified Command Center will help us further our goal of holding every agency accountable by taking precise measurements of performance," Williams said in a written response to questions. "The call center will track one of our most important measures, namely response to 911 phone calls and response times by police, fire and EMS units."

A troubled past

The city's struggles have been watched with interest by other major metropolitan areas trying to improve their emergency performance. But while similar high-tech command centers have opened in other major cities since the 9/11 attacks, Washington has been at the heart of high-profile problems.

A house fire in the Dupont Circle neighborhood in January 2003 in which a young man was killed made headlines after neighbors complained about being kept on hold by 911 operators. A city investigation found that it was not uncommon for 911 calls to go unanswered. About 40% of callers would simply give up.

"People would just hang up," says Suzanne Peck, the city's chief technology officer. The city has since reduced the number of dropped 911 calls to 4% by rooting out both technological and human problems.

Mike Latessa, who became director of the 911 call center in January 2004, says that "human systems" were partly to blame for "unreliable and lengthy" call taking. He found a problematic culture, documented by the USA TODAY investigation.

"Nobody could even explain on a basic level what they were doing," he says. "Mediocre performance was considered outstanding. We had to erase 20 to 30 years of bad habits."

The newspaper's analysis, echoed by a report from the Institute of Medicine this June, found that inconsistent performance by emergency crews nationwide can be improved by strong leaders who insist upon performance monitoring.

In the new dispatch center, a quality-assurance team will be able to hunt for failures in emergency calls. Supervisors on the vast "command floor" of the 138,000-square-foot center will listen in on calls in progress to make sure emergencies are handled properly, Latessa says.

And in offices just off the floor, a quality assurance unit will monitor call takers and dispatchers the way similar teams do in big cities with acclaimed emergency response — Tulsa and Oklahoma City, among others.

For medical calls, the team will compare what dispatchers told responding medics against what actually was wrong with the patients.

Latessa says the team will ensure that 911 call responders understand the emergencies being reported and are sending the right police, fire or ambulance teams to the right place.

The human factor

The facility is designed to withstand bullets and bombs. The staff can remain locked down for 72 hours in a catastrophe. There is a child care center on the site. Critical systems have backups, including power and communication systems. All clocks are synchronized. And every emergency department can communicate with each other.

National experts say it is those people who will plug their headsets into the new consoles who will determine if the center saves lives.

The new center "is an important achievement," says Marc Eckstein, Los Angeles Fire Department's medical director. "But I wouldn't want for anybody to think that technology would supersede people when it comes to quality of patient care."

The death in January of a newspaperman, for instance, came at a time when 911 calls were getting answered quickly, data show.

David Rosenbaum, a longtime New York Times reporter and editor, died after emergency medical crews botched his care, a city investigation found. The inquiry documented "a chain of failures" and called for more emergency medical oversight.

"The response in the Rosenbaum case was a tragedy, but I am convinced that it represents the exception to the rule," Williams says. "Today, emergency phone calls are generally answered quicker and our EMS crews show up sooner than they ever have.

"We are much further along, but we can do better. I believe that applies across the city government."